Title of Presentation Seven Keys to Preventing Clinical Denials When Subjective Decision-Making is the Cause October 28 , 2021 11:30-12:30 (CST) Register in advance for this webinar: Register Here
Description of the goal(s) of the presentation: It is relatively easy to identify the root cause of an inpatient denial due to a procedural matter like failure to obtain an authorization.
But what is the root cause of an inpatient denial when the hospital does everything ‘right’? They notify the correct insurance company on time. They obtain the authorization and provide clinical details to support the inpatient admission. And still, the payer denies the inpatient admission at the time of request opining the inpatient level of care is not medically necessary – that the patient can be treated at a lesser level of care.
This webinar explores why uncovering subjective decision-making, on both the provider and payer side, is the biggest challenge hospitals face in preventing clinical denials. In detail, we review the importance of analyzing and trending seven key data points that are generally unreportable within the hospital’s EMR.
Learning objectives: • To obtain a better understanding of effective and consistent documentation to prevent and overturn clinical denials. • To identify strategies to utilize within the Revenue Cycle/UM processes to prevent denials. • To identify areas of opportunity and process improvement for providers to address and prevent clinical denials. • To obtain pointers and suggestions for drafting persuasive appeals on the provider’s behalf to overturn the denials and hold payers accountable.
Brief outline of the presentation - Description of the Challenge: Analyzing Medical Necessity Denials - The difference between ‘reportable’ and ‘unreportable’ data in your EMR - Exploration of the 7 categories of data that will uncover the true root cause of the denial - Examples of Opportunities for Improvement - How to use the information gathered through this deep dive to create persuasive and effective appeals that get results
Target Audience The webinar is designed for revenue cycle staff and all other personnel involved with appealing, overturning, and preventing clinical denials, including: • Physicians • Physician Advisors • Case Managers • Utilization Review Nurses • CDI Personnel • Nurses • Social Workers • Managed Care • Discharge Planners
Presented by Laurie Beck and Stacy Gearhart with Advicare _______________________________________________________________________ Region 7 Free Webinar: Title of Presentation Revenue Opportunities in Your Uncollectible Bad Debt October 28 , 2021 11:30-12:30 (CST) Register in advance for this webinar: Register Here
Description Brief outline of the presentation In this presentation, Nick McLaughlin explores the revenue opportunities that exist in patient balances that hospitals spend a lot of money to collect, but rarely do. By reducing the financial burden of care on a hospital's Financial Assistance-eligible population, they can enjoy many benefits besides alleviating that burden on their low-income patients. These benefits include: better health outcomes for their patients, higher patient volumes and insurance reimbursement, a more loyal patient-base, higher Medicaid and DSH reimbursement, and more accurate patient liability estimates.
Description of the goal(s) of the presentation: To discuss the opportunity to leverage a hospital's Financial Assistance/Charity Care program to help patients and drive positive financial outcomes for the hospital.
Learning objectives: 1. Learn how to reduce the financial burden of care on indigent patients to improve health outcomes and increase reimbursement. 2. Learn how leveraging your Financial Assistance Program to engage indigent patients can improve Medicaid and DSH reimbursement. 3. Learn how Financial Assistance plays into consumerism and price transparency, can improve the accuracy of patient liability estimates, and how to use it to increase market share. Target Audience Revenue Cycle, Patient Access, Patient Financial Services
Presented by Nick McLaughlin with Hospital Financial Assistance, LLC